Otorhinolaryngology

otolaryngology

 or otorhinolaryngology

Medical specialty dealing with the ear, nose, and throat (see larynx, pharynx). The connection of these structures became known in the late 19th century. Otolaryngologists use an otoscope to examine the eardrum and a laryngoscope (developed in 1855) to inspect the larynx. They also test hearing and prescribe hearing aids. The operating microscope (developed in 1921) and flexible endoscopy now permit them to operate on delicate internal structures.

---

otorhinolaryngology [¦ōd·ə¦rīn·ō‚lar·ən′gäl·ə ·jē]

(medicine)

otolaryngology

---

Otorhinolaryngology 

(also otolaryngology), a clinical discipline concerned with the causes, treatment, and prevention of diseases of the ear, nose, pharynx, larynx, trachea, and adjacent regions. Otology, rhinology, and laryngology were combined into a single discipline because of the anatomical similarities and functional relationships between the involved organs, because of the frequent interdependence of diseases that affect these organs, and because of some methods of diagnosis that are common to all these diseases. Several independent disciplines, namely, audiology, phoniatrics, and otiatry, have emerged from general otorhinolaryngology. Audiology studies the causes, prevention, treatment, and correction of and compensation for deafness and hearing impairments; phoniatrics studies the physiology and pathology of voice and the prevention and treatment of speech defects; and otiatry is concerned with the study and treatment of ear pathology.

Otorhinolaryngology became independent of general surgery and internal medicine and developed into a separate discipline about the mid-19th century. However, special techniques for repairing the nose and ear were known to the people of ancient India, and concrete descriptions of polyps and other pathological conditions of the nose are found in the writings of the ancient Judeans. Some information about nasal anatomy, nasal traumata, and removal of nasal polyps can be found in the works of Hippocrates. Aulus Cornelius Celsus described various diseases of the ear and some methods for their treatment. The beginnings of the experimental study of voice appear in the works of Galen. The writings of the Armenian physician Amir-Dovlat, which date from the 15th century, have 15 chapters on diseases of the ear, nose, and throat. In Russia the records of the Aptekarskii Prikaz (Pharmaceutical Department) mention the specialists in laryngology I. Gubin and V. Gubin (seeAPTEKARSKII PRIKAZ).

Thorough study of the anatomy of the ear, nose, and throat began in the 16th century with the works of A. Vesalius and his students B. Eustachio and G. Fallopio and was continued in the 17th and 18th centuries by, among others, the Italian A. Valsalva, the Englishman N. Highmore, and the Frenchman J. Petit. The physiology of the ear was elucidated and the clinical study of ear diseases was initiated by the French scientist J. Duverney in the 17th century. The development of otorhinolaryngology in the 18th century was promoted by the work of H. Boerhaave, who first described the complete picture of laryngeal diseases; G. Morgagni, who studied the mechanism of swallowing and the production of sounds and speech; and the French surgeon P. Desault, who introduced the technique of laryngotomy and intubation of the larynx through the nose.

In 1800 the English surgeon A. Cooper successfully performed the first paracentesis—incision for the purpose of draining—of the tympanic membrane. Of particular importance was the classic work, published in Prague in 1845, of the Austrian anatomist J. Hyrtl, who studied the anatomy of the inner ear of man and animals. The Viennese school of otiatrists played a major role in the emergence of otorhinolaryngology as an independent discipline. The school was founded and directed by A. Politzer, whose student R. Bárány was among the first to study the vestibular apparatus and propose several devices, for instance, the Bárány chair and gaze-fixer, to investigate this structure. Of great importance were the mirror with a hole in the center (prototype of the modern reflector) for illuminating the deep cavities of the ear and the aural speculum that were proposed in 1841 by the German physician F. Hofmann.

Before the 19th century, hearing was investigated at first only by means of speech and watches and then by tuning forks. Special instruments, including audiometers and sirens, were introduced at the end of the 19th and beginning of the 20th centuries. Hearing is now examined through audiometry (seeAUDIOMETRY).

The principal surgical operations of the ear—trepanation of the mastoid process and radical surgery of the temporal bone— were theoretically and practically worked out in the last quarter of the 19th century. The laryngoscope, which was invented by the Spanish singer and voice teacher M. Garcia in 1859 and improved by the Czech physiologist J. Czermak, made it possible to examine the larynx. A technique for examining the nasal cavities was developed somewhat later, in 1859. Among the first books on otorhinolaryngology were the Frenchman J. Itard’s Treatise on Diseases of the Ear and Hearing (1821), the Austrian L. Türck’s Symptoms of Diseases of the Larynx and Upper Respiratory Tract (1866), and the German B. Fraenkel’s General Diagnosis and Treatment of Diseases of the Nose (1876).

In Russia, P. A. Zagorskii, E. O. Mukhin, and N. I. Pirogov began the study of the anatomy and traumatology of the ear, nose, and throat. The surgeon P. P. Zablotskii-Desiatovskii published a special monograph series of lectures in the 1850’s. The first courses in otorhinolaryngology were given in universities in the 1860’s. The first Russian professor of laryngology (1867) was D. I. Koshlakov, who with I. I. Nasilov, A. F. Prussak, V. N. Nikitin, V. N. Okunev, and B. V. Verkhovskii made significant contributions to the progress of otorhinolaryngology in Russia. In 1893, N. P. Simanovskii, a student of Koshlakov, founded the first department and first clinic of otorhinolaryngology in the Academy of Military Medicine in St. Petersburg. Three years later, S. F. Shtein opened a similar clinic in Moscow. In 1899, Simanovskii organized a special otorhinolaryngology section at the Third Pirogov Congress, and the First All-Russian Congress of Otorhinolaryngologists was held in 1908. The First All-Union Congress of Otorhinolaryngologists was held in 1924 on the initiative of L. T. Levin.

In 1922 otorhinolaryngology became a required course for medical students in the USSR. As of 1973, there were 81 departments of otorhinolaryngology and otorhinolaryngologic research institutes in Moscow, Leningrad, and Kiev. The All-Union Society of Otorhinolaryngologists was founded in 1940. Several large schools came into being, for example, that of V. I. Voiachek and L. T. Levin in Leningrad; A. F. Ivanov, L. I. Sverzhevskii, B. S. Preobrazhenskii, and A. G. Likhachev in Moscow; M. F. Tsytovich in Saratov; L. E. Komendantov in Rostov-on-Don; M. Ia. Kharshak, among others, in Kiev; and S. M. Kompaneets in Kharkov. A. I. Kolomiichenko, N. A. Preobrazhenskii, K. L. Khilov, S. N. Khechinashvili, and V. F. Nikitina were awarded Lenin Prizes in 1964 for developing the surgical treatment of otosclerosis.

Otorhinolaryngologists today are studying occupational diseases of the ear, nose, and throat and methods of treating the sequelae of ear diseases—hearing impairment, deafness, and deaf-mutism. Much research is being conducted on the physiology and pathology of the vestibular apparatus and on cancer of the ear, nose, and throat. Many surgical techniques have been perfected, and operations that are minimally trying for the patient are being developed. Abroad, the work of the Swedish scientist G. Holmgren and the American S. Rosen on the surgical treatment of hearing impairment is well known, as is that of the Polish scientists H. Lewenfisz and J. Miodonski and the Czech A. Přecechtěl on the use of tympanoplasty. Specialized journals in otorhinolaryngology include Vestnik otorinolarin-gologii (Review of Otorhinolaryngology, since 1936), Zhurnal ushnykh, nosovykh i gorlovykh boleznei (Journal of Ear, Nose, and Throat Diseases, since 1924), Acta oto-laryngologica (Stockholm, since 1918), Archives of Otolaryngology (Chicago, since 1925), Laryngoscope (St. Louis, Mo.—Collinsville, Ill, since 1896), and Archiv für Ohren- Nasen- und Kehlkopfheilkunde (Wiirzburg-Leipzig-Berlin-Heidelberg, since 1864).

REFERENCES

Mnogotomnoe rukovodstvo po otorinolaringologii, vols. 1–4. Edited by A. G. Likhachev. Moscow, 1960–63.
Preobrazhenskii, B. S., Ia. S. Temkin, and A. G. Likhachev. Bolezni ukha, nosa i gorla, 7th ed. Moscow, 1968.

N. A. PREOBRAZHENSKII